A randomized controlled trial of transition from insulin pump to multiple daily injections using insulin degludec. Issue 8 (27th June 2021)

• Record Type: Journal Article
• Authors: Shah, Viral N.; Akturk, Halis K.; Joseph, Hal; Schneider, Nicole; Snell‐Bergeon, Janet K.
• Is Part Of: Diabetes, obesity & metabolism. Volume 23:Issue 8(2021)
• Page Start: 1936
• Page End: 1941
• Publication Date: 2021-06-27
• Subjects: basal insulin -- clinical trial -- CSII, insulin pump therapy -- type 1 diabetes; Diabetes -- Periodicals; Obesity -- Periodicals; Metabolism -- Disorders -- Periodicals; Clinical pharmacology -- Periodicals; 616.462
• DOI: 10.1111/dom.14423
• Languages: English
• ISSNs: 1462-8902

Abstract

Abstract: Aim: To evaluate two methods of transition from an insulin pump to multiple daily injections (MDI) using long‐acting insulin degludec (IDeg). Materials and Methods: After a 1‐week run‐in period, adults with type 1 diabetes for longer than 1 year and HbA1c 48‐69 mmol/mol (6.5%‐8.5%), who had been using an insulin pump at least for 6 months, were randomly transitioned to either standard of care (discontinued insulin pump and started IDeg in 1:1 dose) or overlap (IDeg 1:1 at pump basal dose, but pump continued for the first 48 hours with a gradual basal reduction; 50% from 0‐24 hours, 75% from 24‐48 hours and then pump discontinued). Participants used blinded Dexcom G6 and the IDeg dose was not changed during the trial. Primary (% time above 180 mg/dL) and secondary (% time in 70‐180 mg/dL and below 70 mg/dL) outcomes were compared between the two groups during 7 days of randomization. Results: Age, gender, diabetes duration and basal/bolus insulin doses were similar between patients randomized to standard of care ( n = 17) or overlap ( n = 13) transition. Compared with overlap transition, the standard of care group spent 4.8% more time in hyperglycaemia (least square mean 4.8% [95% CI –3.3%, 12.9%]) and 5.3% less time in range (−5.3% [−12.6%, −2.0%]), without a significant difference in hypoglycaemia (0.5% [−2.3%, 3.4%]). No treatment‐related adverse events were noted in either group. Conclusion: The overlap transition method may result in a significant improvement in time‐in‐range without increasing hypoglycaemia during the first week of transition from an insulin pump to MDI using IDeg in adults with type 1 diabetes.